Organization
REVIVE ROOTS, PLLC
Active
Other names
Reviving Roots Therapy & Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
MARLEE DORSEY MA, LPCC (PRESIDENT)
(612) 445-7781
Entity
Organization
Contact information
Practice address
3440 PORTLAND AVE, MINNEAPOLIS, MN 55407-4861
(612) 990-8172
Mailing address
3440 PORTLAND AVE, MINNEAPOLIS, MN 55407-4861
(612) 990-8172
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
01/13/2020
Last updated
09/24/2020
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